28 Years
1983-2011
Hospice Greater Saint John owns and operates both
“Bobby’s Hospice” and “The Hospice Shoppe”
In the fall of 2005,
facing her own end-of-life
illness, Bobby Lawson,
a 20-year Hospice volunteer,
and her family made a
significant donation to enable
Hospice to purchase a home in
the community suitable for a
Residential Hospice.
The Business Case
Community Needs
• 800 people die annually of a palliative illness in the Greater Saint John area.
• Over half of the annual palliative deaths take place in the SJRH
- 200 in the Palliative Care Unit
- 200 in Acute Care Beds
• In the last month of life, 50% of palliative patients are hospitalized because
they need 24-hour care that families are unable to provide.
• SJRH has some of the longest wait times for elective surgery & admissions
from the ER
• Seniors account for 75% of palliative deaths. By the year 2025, the
proportion of seniors in NB is projected to be 21% higher than the national
average.
• Palliative deaths are set to rise significantly, particularly in Saint John, which
has NB’s oldest population
The Business Case
The Community Benefits
Dying Patients – 130 dying patients who will otherwise face hospitalization
annually in the last month of life receive individualized quality end-of-life
comprehensive care in a home-like setting.
• Hospital Wait Times –Residential Hospice frees up over 2,500 acute
care bed days at the SJRH annually and increases access for 500+ patients on
surgical wait lists, etc.
• Families –Hospice palliative care positively influences the quality of dying
and the recovery of survivors. With the death of one person affecting an
average of 5 other people, 650 families are positively affected by Residential
Hospice care.
• Tax Dollars – Government is spending $200/day to care for palliative
patients in the Residential Hospice compared to $1,000/day in an acute care
hospital. Over $2 million dollars/year is being reallocated to acute care
services.
Twinning & Sharing for Success
Carpenter Place, Burlington, ON – www.thecarpenterhospice.com
Hospice May Court, Ottawa, ON – www.hospicemaycourt.com
Vernon & District Hospice, Vernon, BC – www.vernonhospice.ca Thank
Rosedale Hospice, Calgary, AB – www.hospice.calgary.com
Red Deer Hospice, Red Deer, AB – www.reddeerhospice.com You!
Hospice Niagara, St. Catherines, ON – www.hospiceniagara.ca
Dr. Bob Kemp Hospice, Hamilton, ON – www.kemphospice.org
Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association
Janet Dunbrack, Healthcare Consultant and Former Executive Director, CHPCA
Carolyn Tayler, RN, BN, MSA, Director, Hospice Palliative Care, Fraser Health, BC
Ontario & Fraser Health Standards for Residential Hospices
Our Greatest Challenges
• Challenging the status quo
• Selling the unwanted
• Developing a critical mass
• Staying the course
Our Attitude
Secrets of Success
Fearless Leaders & Dedicated Teams
More important than technical brilliance or
political smarts is the need for leaders to be
courageous, persistent and resilient.
It requires tremendous commitment and many sacrifices by
a lot of people to get the job done.
• Dedicated Board of Directors willing to take smart, calculated
risks
• Strong Staff Team to lead the way and manage the current
business units
• Medical Experts to add credibility and rally a community
• Political Champions to open doors and lobby internally
• Community Champions to believe, invest and support
Secrets of Success
Master the art of “The Spin”
People buy want they want, not what they need.
 Selling death services is not what people want.
Package it differently - how your Residential Hospice
will reduce hospital wait times, improve acute care
services and support economic development.
 Tell compelling stories to back up your facts.
 Communicate, communicate, communicate. If you’re
not sick of saying it, you haven’t communicated
enough! On average, it takes hearing or reading a
message 8 times for someone to grasp it.
Secrets of Success
Engage the media and be media savvy
Meet with your newspaper’s editorial board to sell your
plan. If you have a solid business case that will
benefit the community, they will give you thousands
of dollars worth of free publicity that will help inform
the public and encourage political action.
Remember that the media do not exist to support you –
give them newsworthy items to report on, both the
good and the bad. Be honest, fair and smart with your
comments.
Everything you say is ON THE RECORD.
Secrets of Success
Develop political champions
Secure experienced politicians in all parties, at all
levels of government to take up your cause.
They will open doors to government, give you
wise advice and lobby internally for your
project.
Invite them to your public functions.
Give them an opportunity to speak.
Give them recognition.
Praise them publically and in the media.
Secrets of Success
Lean on and learn from others
Take smart, calculated risks
Build relationships with others who have travelled this
path. Let them be your coach and champion. Lean on
them for support, hope, guidance and strength. Learn
from their experiences – don’t reinvent the wheel.
 Do your research and have a solid business plan.
 Have the courage to move forward.
 People and resources will follow.
Secrets of Success
Don’t give up
This will be an amazing, frustrating, exhausting and
exhilarating journey.
 Learn to live on the brink of disaster – it’s the norm.
Keep moving forward.
 Hard times bring strength, solidarity, clarity, unity and
success.
 Things outside of your control will come along to propel
you forward when you need it the most.
 In retrospect, you wouldn’t have missed any of it – you
cannot appreciate the highs without suffering the lows.
$2M Renovation Project
2008 - 2010
Sprinkler System
•Elevator
•Fire System
•New Plumbing System
•Furnace Upgrade
•Window & Lighting Upgrades
•Automatic Generator
•Parking Expansion
•New Flooring
•Architectural Design
•Nurse Call System
•Security Upgrade
•Patient Bedrooms & Bathrooms
Renovation Costs
REVENUE
Capital Campaign Revenue $1,992,049
Hospice Fundraising Surplus $151,815
TOTAL COMMITTED REVENUE $2,143,864
EXPENSES (Inc. 6.5% HST)
Architect $130,000
Bird Construction $1,784,757
Paving + Lines $19,170
Garden of Hope & Healing $12,206
Window Etching $1,095
Energy Audit $1,500
Security System $16,060
Furnace System $73,125
Flooring $94,785
Nurse Call System $9,568
Additional Cupboards $1,598
TOTAL EXPENSES $2,143,864
SURPLUS (DEFICIT) $0
Power of the Dream
A Capital Campaign Strategy for Residential Hospice
1. Build the Dream – 2006 - 2007
 $300,000 raised to purchase our first Hospice
House.
2. Realize the Dream – 2007 – 2010
 $2M raised to renovate and ready for operations
3. Live the Dream Legacy Fund – 2012…
 Endowment fund for bequests, etc. with annual
interest earnings supporting operations
Realize the Dream Capital Campaign
Amount Goal Variance % of Goal
Total Individual Donations $378,590 $200,000 $178,590 189%
Total Physician Donations $56,297 $50,000 $6,297 113%
Total Lawyer Donations $6,725 $40,000 -$33,275 17%
Total Foundation Revenue $401,503 $400,000 $1,503 100%
Total Corporate Donations $276,787 $300,000 -$23,213 92%
Total Service Club Donations $114,589 $100,000 $14,589 115%
Total Government Donations $657,558 $650,000 $7,558 101%
Total Hospice Shoppe Revenue $110,000 $60,000 $50,000 183%
TOTAL REVENUE $2,002,049 $1,800,000 $202,049 111%
Government & Hospice Contract
Annual budget of $1.6M
Hospice – 55%
NB Government – 45%
No fee to patients !!
Partnership Principles
$730,000/year $870,000/year
• Patient’s first
• Hospice governance & administration model
• Partnership evidenced by a contract
• End-of-life care
• Industry best practices –evidenced-based model-
Canadian Residential Hospice standards.
• Quality control
• Stability & predictability
• Integrated with volunteer support
• No duplication – seamless care
• Full accountability and public reporting
Over-Arching Principles
Palliative Care Partners
• Patient and Family first (not about us)
• Seamless care through Triage process.
• Good communication and collaboration
amongst partners
• Right Person, Right Place (Home, PCU, RH),
Right Time
• Patient Preference is respected if possible
• All attempts should be made to avoid ER
10-Bed Residential Hospice
Opened November 2010
Residential Hospice Overview
• 22,000 sq. foot palliative care facility with 24-hour care delivered by
certified and licensed professionals and trained volunteers.
• 10 private home-like bedrooms and bathrooms for end-of-life palliative
care
• 24-hour physician coverage and nursing care with expert pain and
symptom management
• 4 family bedrooms, living rooms, TV room, dining room, kitchen, warm
fireplaces, communication room, etc.
• A playroom for children, a chapel for spiritual reflection and outdoor
garden to connect with nature.
The care at our facility exceeds the
Canadian Standards for Residential Hospice care.
Hospice Care Philosophy
Compassionate Care that Celebrates Life
• Individualized, dignified, respectful and compassionate whole person quality
care that includes physical, emotional, spiritual and social care for both
patients and family members.
This is their journey – their way.
We focus on what is important to patients and families and let them guide the way.
We help people to live fully until the end of life.
We provide non-judgmental, respectful, dignified and compassionate care
and support.
• A home-like, peaceful environment that respects patient and family wishes.
This is their home away from home for the remainder of their life.
We work hard to make people feel comfortable and at home.
We are committed to keeping things as home-like and non-institutional as possible.
We create an environment of peace and tranquility.
We care for this home as if it were our own.
Hospice Care Philosophy
Compassionate Care that Celebrates Life
• Experienced and dedicated staff and volunteers who work together in full
cooperation with each other and with community healthcare partners to
serve patients and families and deliver excellent healthcare and
comprehensive support.
We are here to serve others, not ourselves.
We are dedicated to excellence in our clinical practice and respectful teamwork.
We go the extra mile to provide superior customer service and exceed people’s
expectations.
• A supportive community that provides the funds needed to cover our
share of the operational costs.
We treat our community’s donations as if they were our own funds.
We are cautious with our use of supplies and spending. We don’t waste.
We contribute to Hospice fund raisers to the best of our ability.
Customer Service
“The Pickle”
Hospice is committed to quality customer service and
“giving the pickle” which is about going the extra
mile to make customers happy and fully satisfied.
Our customers include patients, families, donors,
shoppers, community partners and anyone outside the
organization who interacts with the organization to
receive or provide services and/or support.
Admission Guidelines
Terminal care with ongoing
pain & symptom management
• Patient and family aware of diagnosis & prognosis
• End stage disease management & terminal care
• Ongoing pain & symptom management
• Limited diagnostics/disease specific treatment
• Expected length of stay 6 weeks or less
• Cannot stay at home and does not require hospital
care
• No ventilators
• No wandering
Residential Hospice
Admissions
1. From community through Family
Physicians, Extra Mural and the HPC
Outreach Clinic
2. From Hospital via consult to Palliative
Care Unit or direct consult to Hospice
Medical Coverage
Funded by Hospice
• 2 FTE Medical Director – two ½ days per week
Dr. Chris O’Brien
• Two additional ½ days of palliative physician coverage –
Dr. Julia Wildish and Dr. Jennifer Hannigan
• Family physicians encouraged/supported to admit and
follow
• 24-hour call team with physicians from the PCU
Leading the country in RH medical coverage
Nursing & Support
Services
• Nurse Manager – Monday to Friday – Nicole Hamming
• 24-hour Nursing & Personal Care
1 Registered Nurse (RN)
1 Licensed Practical Nurse (LPN)
1 Personal Support Worker (PSW)
• Volunteers in 4-hour shifts 8:00 am – 8:00 pm
Exceeding Ontario Standards
Volunteers
Adding Value
Serving Meals
Doing nails and hair
Running errands
Laundry
Emotional and spiritual support
Playing piano
Baking and cooking
Cleaning, mopping, dishes, changing beds
Massage therapy
• Oxygen and Respiratory Therapy
• Complex Wound Care and Help with Supplies
• Specialized air flow Mattresses
• Liaison Nurse - EMP Hospice Palliative Care Coordinator
• Continuity of care. Frequent visits to patients from their
community EMP nurse ( “ they love to visit”)
• Payer of Last Resort (not had to utilize to date)
• OT /PT / SW
Medications
• Exclusive pharmacy for all patient prescriptions
• Delivery, supply MARS, Flips and holders
Medication discard and Sharps disposal
• Back up supplier for medical supplies
• Staff promo medication discount card
• Future engagement for team rounds
Lives Lived at Hospice
November 2010 – October 17, 2011
• 96 admissions
• 60% from hospital and 40% from home
• 82% are age 65 and older
• 85% cancer diagnosis
• Average PPS on admission – 41%
• 85 deaths; 4 discharges
• Average length of stay: 22 days (16 days outliers removed)
• Over 2,200 beds days saved at SJRH
• Occupancy Rate – 72%
• Projected to care for 130 patients/year
Community Feedback
“How can we even begin to express our
gratitude for all the excellent love and care
that you gave to our Mom during our time
with you.
What started out as a dark and fearful time
into the unknown became a place of joy
and laughter and friendship that made her
final journey a blessed time. She loved
you all and told me so all the time. You
are truly God’s Angels on earth.”
Updated Sept. 2011
Board of Directors
Chief Executive Officer Director of Medical Care
Grief, Spiritual Finance & Nurse Palliative
Shoppe Marketing
Care & Operations Website Manager Support & Food
Managers Manager
Manager Manager Services Manager
Housekeeping
24-hour Food
Shoppe Coordinator
Admin. RH Care Team Services
Clerks
Assistant RN’s, LPN’s Coord(s)
PSW’s
Maintenance
Coordinator
Friends
PS &
Shoppe Of Grief
Kitchen
Vol’s Hospice Vol’s
Vol’s
Vol’s
John Carver’s Policy Governance Model
• Advanced Board Model - not involved in operations
• Board has two employees – CEO and Director of Medical
Care - run operations and report to the Board on outcomes
• Board’s Role –Oversee the affairs of the organization on behalf of the
community and be accountable that the org works and delivers on
community needs
1. Governance and Stewardship
– Confirm strategic direction, delegate authority and evaluate results.
– Review and authorize plans, policies and commitments.
– Ensure compliance with legal and contract requirements.
– Monitor performance outcomes and evaluate the organization work against
quality standards and best practices.
– Ensure dedication to, and use of assets for public benefit.
2. Leadership and Support
– Ensure the long-term financial health of the organization.
– Act as ambassadors to the community and attend special events
– Ensure the Board performs effectively.
Executive Committee Board of Directors
Chief Executive Officer Director of Community HPC
(CEO) Medical Care Network
Management Team Medical Advisory
Committee
Community
Quality Care Triage & Care Team
Operations Committee (IDT Rounds)
Health & Safety
Committee
What Does It Cost To Run A
Residential Hospice for One Year?
Nursing Costs $800,000
General Operations & Management 150,000
Hospice Shoppe 135,000
Medical Supplies & Services 100,000
Events & Promotion 70,000
Food Services 70,000
Maintenance & Housekeeping 65,000
Supplies & Equipment 60,000
Heat, Lights, Water 40,000
Volunteer Services 40,000
Worker’s Compensation 18,000
Laundry & Supplies 15,000
Professional Fees (audit, legal, payroll) 12,000
Phone and Cable TV 8,000
Insurance 8,000
Grounds 6,000
Garbage & Compost 3,000
Total Costs $1,600,000
Where Does the Money Come From?
Govt = 45%
Shoppe = 20%
Events = 15% 3% $730,000/year
Donations = 15% 15%
United Way = 3%
Grants = 2%
45%
15%
2%
20%
$48,911/year $360,000/year
Special Events
December 8-17, 2011
$20,000
Saturday
February 12, 2012
$110,000
Saturday Wednesday
May 12, 2012 June 13, 2012
$50,000 $25,000
77 Catherwood Street
Open Monday – Saturday
West Saint John
10:00 am – 5:00 pm
Thurs & Fri Evenings until
8:00 pm
100% of proceeds fund care at the Residential Hospice
Leading Org. Change
• Tough-Minded Optimist
• Be Somewhat Naïve and Believe it is
Possible
• Make Tremendous Sacrifices
• Doggedly Persistent & Very Resilient
• Surrounded by a Dedicated Team of
Leaders & Champions
• Team’s Greatest Cheerleader
• Be Aware of “Founders’ Syndrome”
• Accept Not Everyone will Make the Journey
• No Matter What – The Journey will be Worth It!
The Tipping Point
We Made It!
“At some time, in some way, we must
all face the end of life.
And most of us share a common hope—that
when death comes to us or to a loved one,
it will be peaceful and free of pain.
We hope to face death and grief surrounded
by a circle of support, feeling safe,
comfortable and cared for.
This is the promise of Hospice
Greater Saint John.”